Investigating the Minimal Clinically Important Difference of Health Status Instruments for Patients with COPD in Pulmonary Rehabilitation

Alma, H.J. (2014) Investigating the Minimal Clinically Important Difference of Health Status Instruments for Patients with COPD in Pulmonary Rehabilitation. thesis, Medicine.

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Abstract

Rationale: COPD is a major public health problem. Health status has become an important tool in the diagnostics and management of the disease. The main instruments are the Clinical COPD Questionnaire (CCQ), the COPD Assessment Test (CAT) and the St. George Respiratory Questionnaire (SGRQ). An issue with these questionnaires is to what extent a change in its score is clinically important to the patient. The Minimal Clinically Important Difference (MCID) is used to define this. The current study aimed to investigate the MCID of the CCQ (0.4), CAT (2.0) and SGRQ (4.0) using multiple approaches, since existing evidence is limited in terms of number of publications and methodology. Methodology: In total 238 patients participated in a 3-week Pulmonary Rehabilitation (PR) programme in Bad Reichenhall, Germany (63% male, 51%FEV1pred., 40 mean packyears, 57 years mean age, 40/39/21% GOLD stage II/III/IV). A full array of approaches was used to assess the MCID: Anchor-based approaches, including patient-referencing, criterion-referencing and questionnaire-referencing, and the distribution-based methods SEM, 1.96SEM and 0.5SD. Results: Patient-referencing led to a MCID for CCQ, CAT and SGRQ of resp. 0.54, 2.96, and 7.14. Criterion-referencing was only significant for the CCQ, resulting in a MCID estimate of 0.33. Questionnaire-referencing suggested MCID ranges for CCQ, CAT and SGRQ of resp. 0.37-0.60, 2.18-3.50, and 6.87-7.71. The one SEM, 1,96SEM and 0.5SD were resp. 0.36, 0.71 and 0.44 (CCQ); 2.01, 3.94 and 2.62 (CAT); and 4.00, 7.84 and 5.85 (SGRQ). Discussion: This study recommends that MCID to be a range, of which the CCQ should be between 0.40 and 0.60. The MCID of the CAT should range from 2.50 to 3.50. Finally, the MCID of the SGRQ should range from 6.00 to 8.00, where minimal clinically important change should be considered. The suggested ranges are for improvement, not for deterioration of health status.

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisor: and Jong, C. de PhD and UMCG, Department of Primary Care Research
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:56
Last Modified:	25 Jun 2020 10:56
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1682

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